Presented by Dr. Katharine Gillis at our annual Women in Mind conference on women's mental health.
She was appointed Chair of the
Department of Psychiatry at the University of Ottawa
in 2009, Interim Head, Department of Psychiatry,
Ottawa Hospital in July 2013; and is a national leader
on psychiatry education.
Taylor & Emmet - Managing Absence MasterclassTom Draper
The employment law experts at Taylor & Emmet recently conducted a T & E Advance Managing Absence Masterclass. The event was fully booked and therefore for those of you who were unable to attend we have shared the slides from the event. If you have any questions on the subject of employee absence please contact Tom Draper on 0114 2184311.
Managing mental health claims and return to work is a challenge for most employers. This slide show demonstrates some positive strategies that can reduce the human and financial cost of psychological disability claims. Organizational Solutions Inc has great success in assisting our clients in the management of disability claims of all varieties physical and psychological in nature.
Taylor & Emmet - Managing Absence MasterclassTom Draper
The employment law experts at Taylor & Emmet recently conducted a T & E Advance Managing Absence Masterclass. The event was fully booked and therefore for those of you who were unable to attend we have shared the slides from the event. If you have any questions on the subject of employee absence please contact Tom Draper on 0114 2184311.
Managing mental health claims and return to work is a challenge for most employers. This slide show demonstrates some positive strategies that can reduce the human and financial cost of psychological disability claims. Organizational Solutions Inc has great success in assisting our clients in the management of disability claims of all varieties physical and psychological in nature.
Benefit Sanctions & Delays: presentation at Wandsworth FoodbankPatrick Torsney
Wandsworth Advice public legal education event with Wandsworth Foodbank on 23 October 2014. Topic: Benefit Sanctions & Delays. More info: http://wandsworthadvice.org.uk/2014/11/04/benefit-sanctions-delays-resources/
Intensive outreach-based support for adults with longstanding, complex AOD is...Uniting ReGen
2017 VAADA Conference presentation - Venetia Brissenden and Kate Petch consider ReGen's Intensive Support Service program model and the capacity of the Care & Recovery Co-ordination service type to support people with complex needs.
We share the key insights from a nation wide 2014 quantitative research study to separate the "nice to haves" from the "must haves" when it comes to health cover
Got the ADA basics down and ready to tackle the graduate level course on the complex ADA issues that trip up even the best of HR and legal professionals? Gary Clark and Will Walden will tackle complex ADA issues, such as:
-Mental illness accommodations in the workplace
-The intersection between the ADA and workplace violence threats
-Medical marijuana, opioid and prescription drug use in the workplace
-Navigating a direct threat to health and safety decision
-Fitness for duty tests and examinations
-Managing employees on extended leaves after FMLA has expired
-Identifying accommodations that previously were per se unreasonable, but now must be considered
Please join Gary and Will as they cover these and other tough ADA issues in the workplace.
HEAR approach to behavior management Live webinar Feb 1 2017wef
Slides presented at the HEAR Approach to Behavior Management live webinar of February 1, 2017, featuring presentations from Dr. Andrew Heck and Carol Garby.
Evelyn Sparks, Acting VP of Professional Practice at The Royal shared her tips for returning to work after taking a leave to recover from a mental illness.
Health Employment - Short term sickness absence and dealing with a pandemic w...Browne Jacobson LLP
This session provides you with top tips and issues to consider when dealing with short term sickness absence Gemma Steele also looks at what you can do during a pandemic.
Benefit Sanctions & Delays: presentation at Wandsworth FoodbankPatrick Torsney
Wandsworth Advice public legal education event with Wandsworth Foodbank on 23 October 2014. Topic: Benefit Sanctions & Delays. More info: http://wandsworthadvice.org.uk/2014/11/04/benefit-sanctions-delays-resources/
Intensive outreach-based support for adults with longstanding, complex AOD is...Uniting ReGen
2017 VAADA Conference presentation - Venetia Brissenden and Kate Petch consider ReGen's Intensive Support Service program model and the capacity of the Care & Recovery Co-ordination service type to support people with complex needs.
We share the key insights from a nation wide 2014 quantitative research study to separate the "nice to haves" from the "must haves" when it comes to health cover
Got the ADA basics down and ready to tackle the graduate level course on the complex ADA issues that trip up even the best of HR and legal professionals? Gary Clark and Will Walden will tackle complex ADA issues, such as:
-Mental illness accommodations in the workplace
-The intersection between the ADA and workplace violence threats
-Medical marijuana, opioid and prescription drug use in the workplace
-Navigating a direct threat to health and safety decision
-Fitness for duty tests and examinations
-Managing employees on extended leaves after FMLA has expired
-Identifying accommodations that previously were per se unreasonable, but now must be considered
Please join Gary and Will as they cover these and other tough ADA issues in the workplace.
HEAR approach to behavior management Live webinar Feb 1 2017wef
Slides presented at the HEAR Approach to Behavior Management live webinar of February 1, 2017, featuring presentations from Dr. Andrew Heck and Carol Garby.
Evelyn Sparks, Acting VP of Professional Practice at The Royal shared her tips for returning to work after taking a leave to recover from a mental illness.
Health Employment - Short term sickness absence and dealing with a pandemic w...Browne Jacobson LLP
This session provides you with top tips and issues to consider when dealing with short term sickness absence Gemma Steele also looks at what you can do during a pandemic.
The Education HR in the North West Conference, January 2018 - Capability and ...Browne Jacobson LLP
This session looks at the definition of disability and the risks associated with this, as well as the role of occupational health and capability dismissals.
According to Mind, 1:4 of people in the UK will encounter a mental health problem in the UK, each year. Although awareness of mental health as a physical illness is starting to increase, many organisations are still unaware of the impact such illnesses can have on the individual, and the devastating effect poor management practices can have on colleagues in certain situations. Such ignorance is concerning – in far too many cases, anxiety, depression and other conditions are treated with ‘lip service’ at best; or as taboo at worst. This session will try and tackle some of the main, down-to-earth matters surrounding mental health in Higher Education Institutions. Sometimes, performance is affected, and this can have a serious adverse effect on the morale and performance of a team or department at large. How straightforward is it to identify and help people who might be struggling? How is it best to tackle poor performance while, at the same time, help an individual or individuals cope with mental health difficulties? Should HEIs introduce transparent strategic mental health awareness policies at the very top? How would one do that? How might it be possible to change an institutional or departmental climate for the better, with other positive knock-on effects this could have on welfare, happiness and performance? How would it be possible to transform understanding and practice at a local and institutional level? Following a brief presentation, this session will be an open forum for the sharing of experiences, suggestions and best practice.
The session will be a fully interactive improvisation workshop in which delegates will be invited to engage in fun and stimulating exercises designed to improve their communication, teamwork and break through any barriers holding them back. The exercises can be categorised as follows: Resilience: By learning to embrace failure, participants will learn how to take something with negative connotations as an opportunity for learning and growth. In the current climate where huge demands are placed on administrators, conquering the fear of failure and being able to reframe a ‘failure’ as a learning opportunity is key.
Embracing change: Exercises designed to nudge participants out of their comfort zones will help them to see that change is an inevitable and necessary part of growth. They will learn that they have talent in areas that they may never have previously considered.
Public speaking: Through involvement in storytelling exercises, participants will build their confidence in public speaking and presentation through creative play. These exercises will give them tips and tricks that they can take away with them and apply to future presentations.
Teamwork: These exercises will help participants to communicate more clearly and freely within a team and can be used for teambuilding and away days after the conference.
Browne Jacobson LLP
HR for Education Conference 2017 - 4th October
Workshop 1A - Gill Martindale and Helen Badger
Managing the day to day reality including effective use of an occupational health referral, getting use out of return to work and stage meetings and dismissal in cases involving a disability.
Teresa Pacelli delived this talk at The Dallas Ergonomics Forum on 18th July 2017.
In her talk she described the costs associated with presenteeism and absenteeism and their impact on the wider organisation. She then offered solutions to the problem of this hidden cost.
How to care plan: when, where, how, why, who. Learm how to create person centered care plans that imporve quality of life, satisfy regulators, and make areal difference
Absenteeism, Destructive Workplace BehaviourCG Hylton Inc.
• Types of absenteeism: culpable, innocent: making the distinction
• Addressing the root causes of absenteeism to determine if it is a symptom of stress, burn-out, addictions etc.
• Proactive strategies and guidance to rectify the behaviour
• Attendance policy: tips and strategies
• Ignoring it won't make it go away: how to communicate expectations, policy and confront the issue
• Determining when termination is appropriate
Similar to WOMEN IN MIND: An approach to sick leave & disability in women with mood disorders (20)
A look at how mental health treatment and research have evolved over the last 10 years and about future possibilities for more effective, personalized treatment approaches.
with Dr. Zul Merali, President and CEO, The Royal's Institute of Mental Health Research
Mental illness is common and disabling but the evidence is that fewer than half of people seek any treatment and few receive any help from specialized mental health professionals. In Canada, there are long waiting lists to see psychological therapists face to face despite the importance of non-drug therapies. One way to address this problem is to use computerized e-therapies which deliver structured mental health treatment via a computer. Dr. Simon Hatcher, Psychiatrist at The Royal's Community Mental Health Program and Vice Chair of Research for the Department of Psychiatry at the University of Ottawa, lead a discussion about the role of technology in mental health treatment. Highlights include: the effectiveness of online mental health treatments and opportunities for innovation and policy change in field of mental health.
Not Criminally Responsible. You may have heard this term used in the news or in movies but what does it really mean? At our most recent Conversations at The Royal lecture, we answered this and many other questions about what it means to be a forensic client.
The evening was presented by Dr. Diane Hoffman-Lacombe, Dr. Anik Gosselin, and Raphaela Fleisher, from the Integrated Forensic program at The Royal.
Are you drinking TOO much?
Alcohol is the most commonly used potentially addictive substance in our society. Alcohol is responsible for over half of the $267 million dollars of substance related hospital costs in Canada. Problematic alcohol use significantly impacts individuals, families, and our community, but many struggle to know if they have a problem and where to go for help.
Learn more: http://www.theroyal.ca/mental-health-centre/news-and-events/newsroom/13411/alcohol-how-much-is-too-much/
While terrorism continues to make headlines around the world, some researchers have suggested that terrorists are mentally ill and have used labels such as psychopathic or sociopathic, narcissistic, paranoid and schizophrenic. Others have argued that there is no evidence to indicate that they are mentally ill, disordered, psychopathic or otherwise psychologically abnormal.
The Royal's Dr. AG Ahmed, Dr. Wadgy Loza and Dr. Pius Adesanmi discuss research findings and reflect on the new meanings and manifestations of terrorism and extremism in Canada and around the world.
Our Conversations lecture 'Hope, Humanity and Empowerment: Strengths-focused Cognitive Behavioural Therapy for Psychosis (& Schizophrenia)' was presented by staff members of the Integrated Forensic, Recovery and Schizophrenia programs at The Royal.
Psychosis can be associated with a variety of mental health problems, including schizophrenia, severe depression, bipolar disorder, anxiety, and post-traumatic stress disorders. While traditional treatments for psychosis have emphasized medication-based strategies, research now suggests that individuals affected by psychosis can greatly benefit from talk therapies such as cognitive behavioural therapy for psychosis (CBTP).
Learn more: www.theroyal.ca
The recent attack in downtown Ottawa has deeply affected our city. We have a powerful desire to stay strong as individuals and as a community yet we are all human so it is natural to feel fear, anxiety and loss after this type of event. Recognizing this, The Royal held a special info session on coping with trauma.
Presenters:
Dr. Jakov Shlik, Clinical Director, Operational Stress Injury Clinic and Anxiety program, The Royal
Michelle Antwi, Operational Stress Injury Clinic, The Royal
Katie Bendell, Operational Stress Injury Clinic, The Royal
As presented at The Royal by:
- Dr. Melanie Willows, Clinical Director, SUCD Program, The Royal
- Dr. Kim Corace, Director, Program Development and Research, SUCD Program, The Royal
Opioid addiction is a large and growing problem affecting our community, especially our young people, women and their families. This session addressed:
· The current state of prescription opioid problems
· Opioid use, abuse, and addiction as it relates to women and parenting
· Risk factors for opioid use about women, with a focus on mental health problems
· Treatment options to help women who struggle with opioid problems
· Reducing the stigma and myths regarding women with opioid use problems
This session included information on the collaborative work being done between The Royal’s Sexual Behaviours Clinic (SBC) and Ottawa Police Service’s High Risk Offender Unit (HROU). Dr. Paul Fedoroff was the moderator and began the presentations with an overview of innovative work being done within the SBC and the common goals of the Clinic and the HROU. Staff Sargent Dana Reynolds and Det. Mark Horton discussed the role of their team in the community based management of high risk sexual offenders. More specifically they discussed the role of the Unit and common legal designations utilized for high risk sexual offenders. Lisa Murphy, M.C.A. provided an overview of sex offender registries (SORs) and public notification and made comparisons between the approaches used in Canada and the United States. A discussion period followed the panel presentations.
As presented by Dr. Mathieu Dufour, Psychiatrist at The Royal, at a special Men's Mental Health Awareness event hosted by The Men's D.E.N. (Depression Education Network).
Dr. Andrew Wiens, Head, Division of Geriatric Psychiatry at The Royal, talks about behaviour issues in dementia at our monthly lecture series, Conversations.
As presented at our Conversations at The Royal on March 20, 2014 by speakers Karen James, Cynthia DuBaie, and Richard Cottingham.
More at www.theroyal.ca
“Love Sense” (written by Dr. Sue Johnson): the revolutionary new science of romantic relationships offers the reader a ground breaking guide to the new science of love and loving that has emerged in the last 15 years. The science allows us not just to “fall” in love but to make sense of and shape our most precious relationships.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
3. Learning Goals and Objectives
• Review key principles for documentation for sick leave or disability–
chart notes, sick notes, 3rd party letters and forms
• Provide a tool/guide to assist documentation
• Understand principles of appropriate advocacy
4. Mental Health in the Workplace
• Mental health problems and illnesses typically account for approximately
30 percent of short- and long-term disability claims
• Women are more likely than men to experience depression
• Mental health problems rated on top 3 drivers of both short- and longterm disability claims
• In 2010, 47% of approved disability claims in federal civil service, almost
double the percentage of twenty years earlier
• Mental health problems and illnesses also account for more than $6
billion in lost productivity costs due to absenteeism and presenteeism
http://strategy.mentalhealthcommission.ca/the-facts/
5. Return to Work (RTW) Statistics
Percentage Likelihood of Returning
to Work
60
50
40
30
20
10
0
6
12
24
Months Off Work
6. Your patient/client is struggling. Is time
off work indicated?
• Is time off work your idea, your patient’s or both of yours
• Are you thinking of a short time sick leave - less than 2 weeks
• What will happen if not ready to return at end of 2 weeks
• From the start are you thinking longer than 2 weeks, if so why
• You need to access functional impairment
• You need to know about their job
7. Assessing Function
• Activities of daily living (ADLs)
• Social
• Occupational
• Have there been specific incidents especially in the work place such
as poor performance review; frequent absences, loss of job.
• Tools such as Work and Social Adjustment Scale WSAS
8. Workplace Description
• Ask: What do you do in a typical work day?
• Physical and psychological demands
• Responsibilities
• Ability to work safely
• Individual or team work
• Relations with customers, co-workers and employer
• Shift schedule
• Travel requirements – is a drivers license required
• Are there substances (ETOH, MJ) readily available e.g. restaurant, bar
9. General Considerations When Recommending Sick
Leave
• In your notes and mind be clear on your diagnosis
• Stress is not a DSM diagnosis
• Your notes need to support the diagnosis by documenting the
symptoms
• Consider a reduction in work hours vs off work fully
• When in doubt, keep patient in the workplace and follow
10. Sick Note to Employer
• Work absence is ‘for medical reasons’ or ‘second to medical condition’
rather than DSM dx
• If patient insists on specific DSM dx, consider if his/her judgment
impaired
• Stigma of mental illness in some workplaces may impair future
career
11. Management Plan for Sick Leave
• Don’t procrastinate – have a plan!
• Know your local psychosocial resources
• Start medication and/or psychosocial plan early
• Time off work is not a treatment
12. Letters or Forms for 3rd Party Insurer
• Clinical notes are often requested. They should reflect info put in
insurance forms/letters.
• Document:
• DSMIV Axis 1-5/GAF consistent with other information
provided
• GAF (Global Assessment of Function) score really matters
• GAF of 50 associated with incapacity to work
• Complicating social or work factors
• Treatment response or FAILURE
• Difficulties with unavailable resources or long wait times
** in next 12-24 months DSM 5
13. Sick Leave vs Disability
• Depending on employees benefits sick leave (short term leave)
coverage can range from none, a few weeks to 3 months
• Disability (long term leave) depending on insurer may begin after a 3
month or 6 month period of sick leave
• Forms to physicians usually increase or start when disability begins
• At 2 year mark most plans stipulate in policy employee must apply for
Canadian Pension Plan (CPP)
• If CPP approved, forms to physicians usually decrease
• Insurer costs decrease as CPP provides a co-pay
• If CPP not approved forms typically increase
14. Appropriate Advocacy
• Goal: optimize patient functioning
• Remind patient: Work is healthy!
• Graduated RTW trial often successful
• If impairment persists despite treatment, seek extension of leave
• Seek second opinion
• Not compromising your professional integrity
• Effective advocacy requires good documentation (co-morbities,
failed trials, access problems to recommended treatment)
15. Patient/Client Does not want Insurer to Know
the Psychiatric Diagnosis
• You must have patient’s written permission to complete any
insurance forms
• You have an ethical and professional responsibility to fill forms out
honestly or your license and practice can be jeopardized
• Most insurers will eventually ask for a copy of your medical records,
the patient should be informed of this
• If she does not agree to you filling out form honestly or gives
permission but puts in qualifiers afterwards do not complete the form.
• Document your concerns in the medical record and the reasons why
you can not complete the form. Consult CMPA if needed
16. Factors that impact return to work prognosis
• Is workplace supportive?
• Are there fair workplace practices?
• Is there reasonable effort-reward balance?
• Does patient like his/her work?
• Is he/she capable of tasks when not ill?
• Is there harassment (perceived or real), personality conflicts or legal
issues?
• Is there an Employee Assistance Program .Was it accessed?
17. Strategies for Minimizing RTW Avoidance
• Talk about anticipated return to the work place with first sick
leave note
• Invite patient/client participation in decision
• Set a date you have mutually agreed upon and work toward it.
• Keep the goal of return to the work place prominent in the
treatment/recovery follow up
• Where possible get patient back to work earlier than later with
a graduated conditional Return To Work (RTW) as extended
work absence may cause anxiety
•
18. More RTW Strategies
• Encourage patient/client’s on-going communication with workplace,
case manager, insurance company
• With her permission consider interacting with insurer or workplace.
Have patient present using speaker phone if possible.
• If interacting with workplace remember stigma issues
• Encourage patient to learn more about their mental health recovery.
19. When RTW Avoidance is Present
Treatment plan may include:
• Day hospital program
•
Workplace rehab strategy, insurer may be able to arrange
• Work related refresher course
• Voluntary work experience (to build confidence) before RTW
• Treatment-responsive individuals may fear relapse on return to
toxic work environment. Document your concerns on forms prior to
RTW & monitor on return to work (give a trial of return to work)
20. When You and Your Patient/Client Disagree
• She feels not ready to return to work but you feel she is
• Are there other new active management plans or no need of further
interventions
• Inform her that you can not jeopardize your license and professional
integrity, forms must be completed honestly
• Can complete form with statement that she feels she is unable to return
to work and why (wording can be reviewed with her)
• GAF , PHQ9 scores and your clinical notes provide objective data
• You do not make the decision on benefits, you are providing information
for the insurer to make their decision
•
21. An Approach for Assessing Sick Leave and Disability
None
Mild
Moderate
Severe
None
Mild
Moderate
Severe
Adjustment Disorder
Major Depression - consider using Ham
D7 or SIGECAPS or PHQ-9
Diagnosis
(Denote primary dx)
Psychosis
Anxiety
Dysthymia
Substance Disorder
PTSD
Personality Disorder/Traits
Learning Disability
Medical
Condition
Fibromyalgia
Chronic Fatigue
Chronic Pain
Other:
Overall Illness Risk
Work Place Assessment
None
Lack of motivation to return to work
Lack of support at work
Lack of fair processes at work
Presence of conflict at work
Presence of an effort/reward imbalance
Lack of personal control in workplace
Demands placed on patient
Overall Workplace Risk
Mild
Moderate
High
Past Hx
22. Activities of Daily Living Functional Assessment
Social Functional Assessment
Impairment from Baseline Function
Degree of Impairment from Baseline Function
None
Mild
Moderate
High
None
Shopping
Withdrawal
Food preparation
Breakdown in personal relationships
Transportation
Losses
Overall ADL Impairment Risk
High
Inappropriate behaviour
Accounting
Moderate
Aggressiveness
House work
Mild
Overall Social Impairment Risk
Cognitive Functional Assessment
Overall Prognosis
Degree of Impairment from Baseline Function
Degree of Impairment from Baseline Function
None
Mild
Moderate
High
None
Concentration / focus
Overall Illness Risk
Understanding / comprehension
Overall Workplace Risk
Memory
Overall ADL Impairment Risk
Ability to meet deadlines
Overall Social Impairment Risk
Ability to make decisions
Overall Cognitive Impairment Risk
* This GRID is not validated. Updated December 2012
Overall Cognitive Impairment Risk
Overall Risk
Mild
Moderate
High
24. “
A WSAS score above 20 appears to suggest moderately severe or worse psychopathology.
SERENITY PROGRAMME™ - SERENE.ME.UK - WORK AND SOCIAL ADJUSTMENT SCALE - WSAS
MUNDT, J. C., I. M. MARKS, ET AL. (2002). "THE WORK AND SOCIAL ADJUSTMENT SCALE: A SIMPLE MEASURE OF IMPAIRMENT IN
FUNCTIONING." BR. J. PSYCHIATRY 180: 461-4.
25. References
Bender A, 2011 Disability and Insurance Claims in Primary Care In Goldbloom D.& Davine J (Eds). Psychiatry in Primary
Care: a Concise Canadian Pocket Guide, (pages 274-281). Toronto: Centre for Addiction and Mental Health
Bilsker D et al “Managing Depression – Related Occupational Disability: A Pragmatic Approach”. Canadian Journal of
Psychiatry, Vol 51, No 2, February 2006, 76-83
Butler, Don, (2011, June 28). “PS disability claims soaring.” Ottawa Citizen.
Dong A et al, “Mental Illness and Workplace Absenteeism: Exploring Risk Factors and Effective Return to Work Strategies”,
April 01,2002, OMA Committee on Work and Health
Dorian B & Bender A, 2010 Assessment of Patients for Insurance and Disability, in D.S. Goldbloom (Ed,), Psychiatric Clinical
Skills, ( Rev. 1st ed.; pages 277-292). Toronto: Centre for Addiction and Mental Health
Khullar A & McIntyre R, “An Approach to Managing Depression” Canadian Family Physician, Vol 50, October 2004, pages
1374-1380
Sairanen, S., Matzanke, D., & Smeall, D. (2011). The business case: Collaborating to help employees maintain their mental
well-being. Healthcare Papers, 11, 78–84.
Sanderson K, Andrews G, “ Common Mental Disorders in the Workplace: Recent Findings From Descriptive and Social
Epidemiology”, Canadian Journal of Psychiatry, Vol 51, No 2, February 2006, 63-74
Smetanin, P., Stiff, D., Briante, C., Adair, C., Ahmad, S., & Khan, M. (2011). The life and economic impact of major mental
illnesses in Canada: 2011 to 2041. RiskAnalytica, on behalf of the Mental Health Commission of Canada.
Towers, Watson. (2012). Pathway to health and productivity. 2011/2012 Staying @Work survey report. North America.
Retrieved from http://www.towerswatson.com/assets/pdf/6031/Towers-Watson-Staying-at-Work-Report.pdf.
Wiseman Stephen, 10 Tips for Dealing with Disability Claims, The Medical Post, March, 2007